Jail: The best treatment for mental illness?
By Paul M. Weyrich
web posted March 14, 2005
My brand of conservatism is cultural conservatism. It's a
completely different strand of thought than extreme libertarianism
which sees no real place for government at all. Cultural
conservatism believes in limited government and we often work
in coalition with sensible libertarians and more free-market-
oriented conservatives on important issues upon which we agree,
namely reducing the size of the Federal Government. One
important distinguishing feature of cultural conservatism is that we
believe in upholding the importance of traditional values in a
community. We also are concerned for those who cannot truly
care for themselves but we place more faith in private and
religious institutions than in government bureaucracies to truly
help those in need.
Conservatives such as Tommy Thompson, when he was
Governor of Wisconsin, demonstrated that concern when he
promoted welfare reform. Many people in his state were ticked
off -- rightly so -- that people would receive government checks
in lieu of working. They would have children without being able
to support them independently. Thompson realized that the
hardworking taxpayers had a legitimate gripe. He also knew that
the welfare recipients were really the biggest victims. The
government helped to lock them into poverty without providing
the motivation to improve their lot in life.
Worse, the odds were that their children would also become
trapped in that same poverty. Thompson pushed the boundaries
by obtaining waivers from the Federal Government to permit the
State Government to require welfare recipients to hold jobs in
order to receive their benefits.
Wisconsin's efforts to break the cycle of poverty that started
under Thompson continue.
CATO Institute issued a state report card on welfare reform last
year. Wisconsin received an "A" for its program. "Thanks to
Wisconsin's innovative Work First and Pay for Performance
programs, plus the very real threat that nonworking people will
simply be cut off, almost 67 percent of welfare recipients are
working," wrote CATO Institute welfare policy analyst Jennifer
Zeigler.
Thompson's leadership in reforming welfare helped to trigger a
national revolution for the better. Wisconsin's welfare reform
helped demonstrate to the poor that they could break the
government chains that perpetuated their poverty. Left to the will
of the government's bureaucrats in the state social service
agencies, it's unlikely that welfare reform would ever have
occurred.
Some people are truly helpless. America's mentally ill have been
placed on the streets, often ill prepared or not being provided the
medical care they need. This started during the 1960s when the
state-operated hospitals for the mentally ill fell under fire for their
poor management. Organizations such as the American Civil
Liberties Union exacerbated the problem by pushing for
deinstitutionalization. A lack of affordable housing, particularly
the disappearance of single-residence occupancy housing,
helped to exacerbate the problem. Turning the mentally ill out of
the institutions brought about results that proved to be as
disappointing as when they were in mismanaged institutions.
The result is that many mentally ill are homeless, wandering the
streets, sometimes even posing a danger to the community,
because their illness is untreated. It's quite likely you have seen
an unkempt person acting belligerently, even threateningly,
behaving in a manner as no rational person ever would dream of
behaving. That person is mentally ill and the likelihood is that he
has fallen through the cracks of our system particularly if he has
no family or comes from one without the means to pay for
expensive treatments.
However, there is a new de facto hospital for the mentally ill:
America's prison system. The mentally ill, left to fend for
themselves, often end up running afoul of law enforcement
because of their aggressive behavior. Some very well may have
broken the law but quite often the police do not understand the
mentally ill person is displaying symptoms of illness. The police
often do not realize that the mentally ill have grandiose feelings
and that makes them very difficult to handle, adding to the
burden already upon the police.
The problem is that the prisons are no place to house those who
truly are mentally ill. When Cheri Nolan, Deputy Assistant
Attorney General, Office of Justice Programs, testified before the
House Judiciary Committee's Subcommittee on Crime,
Terrorism and Homeland Security last year she stated: "If the
crime is serious, incarceration is the appropriate response,
regardless of whether the perpetrator has a mental illness. Our
policy is clear: we will not absolve someone of any responsibility
for committing a crime simply because he or she has a mental
illness."
Nolan explained that many of the mentally ill are jailed for
committing low-level crimes only to be placed on the streets
where they will once again commit the same crimes. In this case
the justice system is equivalent to the dog chasing its tail
endlessly. The mentally ill who are jailed are strong candidates
for return visits once they are released. Ms. Nolan testified that
the Los Angeles County Board of Supervisor's Task Force on
Incarcerated Mentally Ill found that 90 percent of the county's
inmates who have mental illnesses are repeat offenders. Too
many mentally ill leave jails where their needs for treatment have
not been provided, ending up on the streets without the needed
connections for treatment, housing and the support services they
need and the result is they end up in prison once more.
Many localities and states are failing to come to terms with the
problem of the mentally ill. The Treatment Advocacy Center
says eight states do not mandate treatment in the community
setting -- Connecticut, Maine, Maryland, Massachusetts,
Nevada, New Jersey, New Mexico and Tennessee. This can
help push the mentally ill into the hands of law enforcement and
prison guards rather than medical personnel. Pennsylvania's law
governing the treatment of the mentally ill has required since the
mid-1970s that dangerousness be a determining condition for
arrests. Philadelphia's Police Chief ordered that the mentally ill
be arrested for disorderly conduct rather than placed into
custody under the Mental Health Act. The Treatment Advocacy
Center in a February 2005 briefing paper on "Law Enforcement
and People with Severe Mental Illnesses" says "That practice
continues today when officers and deputies find there is no way
to get psychiatric help for a person who is psychotic but not yet
o!
bviously dangerous."
Steve Leifman, a Judge who sits on Florida's Eleventh Circuit,
which covers Miami-Dade County, explained the problem in a
letter posted on January 9, 2005 on the Miami Herald's
Miami.com website: "[People with mental illness] are arrested
and jailed for minor offenses and nuisance behavior, such as
disorderly conduct or trespassing. Once incarcerated, they
remain jailed eight times longer -- and at a cost that is seven
times greater -- than those without mental illnesses arrested for
the same offenses." The Judicial Circuit upon which he serves
instituted a program to divert the mentally ill from the criminal
justice system to obtain treatment for their illnesses. Law officers
have received training in how to recognize and to better deal with
the mentally ill. Leifman wrote that the recidivism rate among the
mentally ill in Dade County has fallen dramatically and that
taxpayers are saved over $2.3 million annually.
Memphis' police force has a special crisis intervention team
which personnel specifically are trained to handle people with
mental illnesses. The Treatment Advocacy Center states that
police's Crisis Intervention Team (CIT) personnel "learn to
interact with people with mental illness who are in crisis in a way
that de-escalates, rather than inflames a tense situation. CIT
officers can also divert a person to a mental health treatment
facility rather than jail when appropriate." Portland, Oregon,
Seattle, Houston and San Jose are some other cities that are
using similar approaches.
More effort needs to be put forth to assure the police understand
the problems of the mentally ill and how best to deal with them.
In many cases sensible treatment is vastly preferable in terms of
cost and compassion than incarceration. A return to
institutionalization may be warranted for some hard-luck cases
although it will be important to administer the facilities well to
prevent the scandals that helped fuel the drive for
deinstitutionalization in the first place. It's important that the law
enforcement and the courts seek to provide appropriate
responses to the mentally ill who have yet to commit true crimes
of violence. Ensuring they receive treatment may even help to
prevent even worse crimes from occurring. "Go directly to jail" is
not the right path to take in such cases.
Paul M. Weyrich is Chairman and CEO of the Free Congress
Foundation.
Enter Stage Right -- http://www.enterstageright.com